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Interdisziplinäre Behandlung spontaner A.-carotis-Sinus-cavernosus-Fisteln über die offene Punktion der V. ophthalmica superior

Interdisciplinary treatment of carotid cavernous fistulas via the superior ophthalmic vein

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Zusammenfassung

Hintergrund

A.-carotis-Sinus-cavernosus-Fisteln (CCF) sind arteriovenöse Kurzschlussverbindungen zwischen der A. carotis interna oder externa und dem Sinus cavernosus (SC). Die Beeinträchtigung der venösen Drainage in der Orbita kann zu schwerwiegenden ophthalmologischen Komplikationen führen. Die klassische Therapie besteht derzeit in der interventionellen Embolisation über einen arteriellen Zugang.

Fallberichte

Aufgrund anatomischer Besonderheiten war bei zwei Patienten mit CCF kein konventionelles transarterielles Vorgehen möglich. Der interdisziplinäre Fistelverschluss mit Platincoils wurde in beiden Fällen nach transpalpebraler Präparation und offener Punktion der V. ophthalmica superior (VOS) durchgeführt.

Ergebnisse

Nach Verschluss der CCF bildeten sich die ophthalmologischen Symptome vollständig zurück. Als Komplikation des operativen Zuganges verbleibt bei beiden Patienten eine funktionell unbedeutende Restptose des Oberlides.

Schlussfolgerung

Bei sorgfältiger Indikationsstellung ist die operative Darstellung und Punktion der VOS in der vorderen medialen Orbita mit nachfolgender Embolisation des Sinus cavernosus ein effizientes Verfahren in der interdisziplinären Behandlung therapieresistenter CCF.

Abstract

Background

The endovascular occlusion of symptomatic carotid cavernous fistulae (CCF) via the transfemoral approach is safe and effective. Due to anatomical variations or after unsuccessful transarterial therapy, a direct surgical approach to the superior ophthalmic vein (SOV) may be necessary.

Case reports

In two patients with acute ophthalmologic symptoms coil occlusion of the CCF was performed after palpebral incision and cannulation of the SOV.

Results

In both patients preparation of the SOV was performed successfully and without complications. After coil embolization of the CCF both patients had complete resolution of symptoms within several weeks. During a follow-up of 12 months there were no recurrences, but both patients exhibited moderate blepharoptosis.

Conclusion

Embolization of CCF via a surgically created approach is an effective procedure in selected cases when standard interventional treatment is not possible.

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Authors and Affiliations

  1. Klinik für Mund-Kiefer-Gesichtschirurgie, Dr. Horst Schmidt Kliniken Wiesbaden

    C. Kuettner

  2. Abteilung für Neuroradiologie, Medizinische Hochschule Hannover

    F. Goetz

  3. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover

    P. Brachvogel

  4. Klinik für Mund-, Kiefer- und Gesichtschirurgie, Georg-August-Universität Göttingen

    F.-J. Kramer

  5. Burgstraße 2–4, 65183, Wiesbaden

    C. Kuettner

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  1. C. Kuettner
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  2. F. Goetz
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Correspondence to C. Kuettner.

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Kuettner, C., Goetz, F., Kramer, FJ. et al. Interdisziplinäre Behandlung spontaner A.-carotis-Sinus-cavernosus-Fisteln über die offene Punktion der V. ophthalmica superior. Mund Kiefer GesichtsChir 10, 56–62 (2006). https://doi.org/10.1007/s10006-005-0654-0

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